Cardiorespiratory Assessment:
The aim of assessment is to confirm diagnosis, disease severity, symptoms, and patients’
perceptions, rule out red flags and identify if escalation is necessary, formulate treatment plan and
ensure patient’s treatment, medication and self-management skills are optimized, evaluate current
treatment, and recognize change and refer to appropriate teams/services as required.
Key points to remember before assessment:
Gather essential documentation, read patient notes prior.
Prepare PPR and essential equipment needed.
Bare below elbow, hair tied up, hand hygiene, appropriately dressed.
Subjective Assessment:
The subjective assessment is an interview type of conversation with eh patient. Here you will gather
essential information. This part of the assessment should generally begin with an open-ended
question such as “What brings you to the clinic today?” or “What is troubling you the most?”, this
will allow the patient to discuss the problems that are most important to them at the time.
Throughout the subjective assessment the questions that you ask can become more and more
focused on the important features that you picked up on.
Key things to ask for all patients regardless of setting:
Presenting condition /History of presenting condition (PC/HPC) – This will summarize the
patient’s current problems as well as the relevant information from the medical notes.
Previous Medical History (PMHx) – This will summarize the patients entire medical/surgical
history and identify the problems that they have had in the past. If reading from the
electronic database, it may be in disease specific groupings or in chronological order.
Drug History (DHx) – This will identify any current medications including dosage. Drug
allergies may also be noted here.
Family History (FHx) – This will include a list of any major disease or illness suffered by the
immediate family.
Social History (SHx) – This will paint a picture of the patient’s current social situation. This
will be important to identify the level of support available at home, current/past occupation,
family life, responsibilities/household duties, and ADL’s. The layout of the patient’s home
should be noted for example, stairs and accessibility for the patient. Finally, history of
smoking and alcohol use should also be noted here.
Specific Questions to ask in a Cardiorespiratory Setting:
Symptoms, SOB, Cough, Sputum – how long? Colour of sputum, viscosity, how much? (1
teaspoon, 1 egg cup, half a cup, 1 cup).
Onset of symptoms, exercise tolerance, aggs and eases.
Severity, pattern, allergies.
History of previous infections, how many chest infections in 3 months/ 6 months etc.
Vaccination hx.
Childhood illnesses, whooping cough, asthma etc.
Exposure to pollutants, where they live, occupation (past/present).
, Objective Assessment:
The objective assessment is based on the examination of the patient. This is done by a combination
of visual and physical hands-on examination as well of the use of tests and imaging to
confirm/eliminate diagnoses. Although a full examination will be made available from the medical
notes, it is important to make a thorough examination at all times as the patient’s condition may
have changed since the previous examination took place. A good examination will also create an
objective baseline for the patient and be used as a measurement of future progress.
The objective assessment for a Cardiorespiratory patient will involve:
General Observation – This will include:
Neurological Status (Glasgow Coma Scale), Body
Temperature.
Heart Rate, Respiratory Rate.
Blood Pressure (BP).
Body Weight, Capillary refill.
Other Measures* - For the intensive care patient
include, Central Venous Pressure (CVP), Pulmonary
Artery Pressure (PAP), Intracranial Pressure (IP).
Apparatus – such as various lines and tubes,
especially in the intensive care patient.
Intercostal Drains – these are placed between two
ribs into the pleural space to remove air, fluid, or
pus.
The Hands – Look for finger clubbing, tremor,
nicotine stains, warm and sweaty hands, weakness,
or muscle atrophy.
The Eyes – Looks for colour such as pallor
(anaemia), plethora (high haemoglobin), jaundice
(Liver/blood disturbance), pupil size.
The Mouth – Look for cyanosis (bluish tint around lips)
caused by hypoxia.
Jugular Venous Pressure.
Peripheral Oedema.
Chest Observation – This will include:
Chest shape – Kyphosis, Kyphoscoliosis, pectus excavatum (funnel chest), pectus carinatum
(pigeon chest), hyperinflation (where the ribs lose their normal 45-degree angle and become
almost horizontal).
Breathing patterns – Normal breathing (12-16 breaths per min), Prolonged expiration (seen
in patients with obstructive lung disease), Pursed-lip breathing, Tachypnoea (>20 breaths per
min), Bradypnoea (<10 breaths per min), Apnoea (cessation of breathing for >10 secs),
Hypopnoea (shallow breathing), Hypoventilation (reduced total ventilation),
Hyperventilation (increased total ventilation), Kussmaul’s respiration (rapid deep breathing
with a high minute ventilation), Cheyne-Stokes respiration (irregular breathing patterns),
Ataxic breathing (haphazard, uncoordinated breaths), Apneustic breathing (prolonged
inspiration)
The aim of assessment is to confirm diagnosis, disease severity, symptoms, and patients’
perceptions, rule out red flags and identify if escalation is necessary, formulate treatment plan and
ensure patient’s treatment, medication and self-management skills are optimized, evaluate current
treatment, and recognize change and refer to appropriate teams/services as required.
Key points to remember before assessment:
Gather essential documentation, read patient notes prior.
Prepare PPR and essential equipment needed.
Bare below elbow, hair tied up, hand hygiene, appropriately dressed.
Subjective Assessment:
The subjective assessment is an interview type of conversation with eh patient. Here you will gather
essential information. This part of the assessment should generally begin with an open-ended
question such as “What brings you to the clinic today?” or “What is troubling you the most?”, this
will allow the patient to discuss the problems that are most important to them at the time.
Throughout the subjective assessment the questions that you ask can become more and more
focused on the important features that you picked up on.
Key things to ask for all patients regardless of setting:
Presenting condition /History of presenting condition (PC/HPC) – This will summarize the
patient’s current problems as well as the relevant information from the medical notes.
Previous Medical History (PMHx) – This will summarize the patients entire medical/surgical
history and identify the problems that they have had in the past. If reading from the
electronic database, it may be in disease specific groupings or in chronological order.
Drug History (DHx) – This will identify any current medications including dosage. Drug
allergies may also be noted here.
Family History (FHx) – This will include a list of any major disease or illness suffered by the
immediate family.
Social History (SHx) – This will paint a picture of the patient’s current social situation. This
will be important to identify the level of support available at home, current/past occupation,
family life, responsibilities/household duties, and ADL’s. The layout of the patient’s home
should be noted for example, stairs and accessibility for the patient. Finally, history of
smoking and alcohol use should also be noted here.
Specific Questions to ask in a Cardiorespiratory Setting:
Symptoms, SOB, Cough, Sputum – how long? Colour of sputum, viscosity, how much? (1
teaspoon, 1 egg cup, half a cup, 1 cup).
Onset of symptoms, exercise tolerance, aggs and eases.
Severity, pattern, allergies.
History of previous infections, how many chest infections in 3 months/ 6 months etc.
Vaccination hx.
Childhood illnesses, whooping cough, asthma etc.
Exposure to pollutants, where they live, occupation (past/present).
, Objective Assessment:
The objective assessment is based on the examination of the patient. This is done by a combination
of visual and physical hands-on examination as well of the use of tests and imaging to
confirm/eliminate diagnoses. Although a full examination will be made available from the medical
notes, it is important to make a thorough examination at all times as the patient’s condition may
have changed since the previous examination took place. A good examination will also create an
objective baseline for the patient and be used as a measurement of future progress.
The objective assessment for a Cardiorespiratory patient will involve:
General Observation – This will include:
Neurological Status (Glasgow Coma Scale), Body
Temperature.
Heart Rate, Respiratory Rate.
Blood Pressure (BP).
Body Weight, Capillary refill.
Other Measures* - For the intensive care patient
include, Central Venous Pressure (CVP), Pulmonary
Artery Pressure (PAP), Intracranial Pressure (IP).
Apparatus – such as various lines and tubes,
especially in the intensive care patient.
Intercostal Drains – these are placed between two
ribs into the pleural space to remove air, fluid, or
pus.
The Hands – Look for finger clubbing, tremor,
nicotine stains, warm and sweaty hands, weakness,
or muscle atrophy.
The Eyes – Looks for colour such as pallor
(anaemia), plethora (high haemoglobin), jaundice
(Liver/blood disturbance), pupil size.
The Mouth – Look for cyanosis (bluish tint around lips)
caused by hypoxia.
Jugular Venous Pressure.
Peripheral Oedema.
Chest Observation – This will include:
Chest shape – Kyphosis, Kyphoscoliosis, pectus excavatum (funnel chest), pectus carinatum
(pigeon chest), hyperinflation (where the ribs lose their normal 45-degree angle and become
almost horizontal).
Breathing patterns – Normal breathing (12-16 breaths per min), Prolonged expiration (seen
in patients with obstructive lung disease), Pursed-lip breathing, Tachypnoea (>20 breaths per
min), Bradypnoea (<10 breaths per min), Apnoea (cessation of breathing for >10 secs),
Hypopnoea (shallow breathing), Hypoventilation (reduced total ventilation),
Hyperventilation (increased total ventilation), Kussmaul’s respiration (rapid deep breathing
with a high minute ventilation), Cheyne-Stokes respiration (irregular breathing patterns),
Ataxic breathing (haphazard, uncoordinated breaths), Apneustic breathing (prolonged
inspiration)
